AFM Task Force Report

Slide 1

AFM Taskforce, Co-Chairs Ruth Lynfield and Jill Taylor

AFM Task Force

Co-Chairs: Ruth Lynfield and Jill Taylor

Slide 2

AFM Taskforce Membership includes BSC members and AFM clinical and research experts

AFM Task Force Membership

View CDC Acute Flaccid Myelitis Task Force Members for full listing

Slide 3

Parents perspectives

Parents’ Perspectives

  • Jeremy Wilcox
  • Rachel Scott
  • Robin Roberts

Slide 4

Neurologic and clinical session

Neurologic/Clinical Session

Support for the emergence of novel AFM epidemiology in 2014

  • Rapidity of paralysis, epidemiologic pattern of cases and degree of cervical involvement distinguish AFM from other paralytic diseases like transverse myelitis
  • Striking biennial, seasonal peaks
  • Sporadic cases may have occurred previously, and received other diagnoses

Support for use of sensitive clinical criteria (acute flaccid weakness) for surveillance purposes

  • Subsequent analysis of sub-populations
    • Sensitive definition will further characterize spectrum of illness
    • Specific definition will inform research questions around etiology and pathogenesis

Slide 5

Neurological and clinical continued, page 5

Neurologic/Clinical Session Continued

Understanding MRI lesions can help inform pathogenesis

  • The timing of the MRI critical to interpretation of findings
  • In patients with only cervical cord affected by MRI, lower extremity weakness due to white matter involvement
  • Important to consider treatment modalities for both grey and white matter disease within the cord

Support for rigorous and standardized long term follow-up with strength and functional assessments

Recognize that analysis of treatment outcomes exceedingly difficult with small patient pool and lack of standardized measurements across institutions

Slide 6

Virology and pathogen discovery

Virology & Pathogen Discovery

  • Support for link between preceding virus-like illness and AFM
  • EV-D68 remains the leading hypothesis for virus trigger despite other EV/RV detections and majority of respiratory specimens negative
  • Support for understanding duration of shedding to interpret respiratory specimen results and timing of specimen collection
  • Support for improved understanding of enterovirus epidemiology (temporal and geographic) in the US with focus on respiratory disease
  • The failure to consistently detect a pathogen in the CSF is likely to remain true even with the planned enhanced discovery methods

Slide 7

Host immune response and immune-mediated pathogenesis

Host Immune Response and Immune-mediated Pathogenesis

Support for measuring antibody response to infection in serum and CSF

  • Diagnostic (intrathecal), pathogenic antibodies (autoantibodies)
  • Antibody-dependent enhancement

Support for broad approaches to measuring pathogen-specific responses

  • Multi-pathogen peptide microarrays
  • Immune cell receptor repertoire profiling

Support for measuring and characterizing EV-D68 population immunity

Kinetics of disease suggest that antibody-mediated pathology is unlikely

  • Low priority given to measuring autoantibody responses

Slide 8

Host risk factors

Host Risk Factors

General support for assessing genetic risk factors associated with AFM

Recognition that host genetics studies can be complex and expensive

Target specific gene subsets

  • Central nervous system, immune system
  • Factors that influence tissue susceptibility: receptor polymorphisms

Support for detailed, structured interviews with families to uncover other potential risk factors

  • Environmental, behavioral

Slide 9

Themes that came out of the AFM Taskforce meeting

Themes That Came Out of the AFM Task Force Meetings

  • Important to have strong collaboration encompassing CDC, NIH, expert academic partners and health departments
  • Need for understanding CNS damage: direct pathogen effects, immune response
  • Non-human primate model and other model systems may be useful
  • Continue work on pathogen detection
  • Review and summarize clinical phenotypes of cases

Slide 10

Themes that came out of the AFM Taskforce meeting

Themes That Came Out of the AFM Task Force Meetings, Continued

  • Strengthen case identification and surveillance
  • Work with partners to optimize recognition of AFM
  • Utilize surveillance for risk factor and other studies
  • Strengthen and expand education and communication outreach
  • Implement natural history study to better understand pathogen(s), pathogenesis and long-term outcomes
  • Continue close dialogue with parents and families on a variety of issues
  • Medical record interoperability

Slide 11

Questions for BSC

Questions for BSC

Do you agree with themes?

Any other areas to consider?

Suggestions for ways to increase engagement of clinicians and public health?

Slide 12


AFM Task Force Members, Noah Aleshire, Tami Skoff, Manisha Patel, Janell Routh, Adriana Lopez, Kathleen Dooling, Tom Clark, Steve Oberste, Mark Pallansch, William Weldon, Nancy Messonnier, Susan Gerber, Sarah Wiley

Slide 13

Thank You

Thank You!

Page last reviewed: December 14, 2018